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North Dakota enrollment in QHPs

21,666 people enrolled in private plans through North Dakota’s exchange during the open enrollment period for 2020 health plans (November 1 – December 15, plus a short extension through December 17).

That was just slightly lower than the 21,820 people who enrolled in 2019.

In most states that use HealthCare.gov, enrollment peaked in 2016 and has declined each year since then. But in North Dakota, the first enrollment decline (of about 3 percent) happened in 2019. The year before, in 2018, there had been 22,486 people enrolled, and enrollment had increased each year from 2014 through 2018.

North Dakota Medicaid/CHIP enrollment

Accepting federal funds to expand Medicaid in North Dakota has been a key aspect of the law’s success there. All legal residents with incomes up to 138 percent of poverty are now eligible for Medicaid.

The state had initially projected that 35,000 people would be newly eligible for coverage, but as of the end of 2018, enrollment in Medicaid expansion in North Dakota was only a little over 20,000 people.

Enrollment in Medicaid continues year-round. The initial legislation to expand Medicaid under the ACA was slated to expire in July 2017, but the legislature has continued to renew the program.

The 2017 edition of America’s Health Rankings placed North Dakota slightly higher, at 18th place — although this was a drop of seven spots since the 2016 ranking, with North Dakota dropping more than any other state.

Trust for America’s Health has summarized additional information on the state’s specific disease incidence and health factors for adults and children. The details are in the 2016 listing of Key Health Data About North Dakota.

You can also view North Dakota health data on a county level with this interactive map showing the counties in North Dakota based on their public health outcomes and health factors. High- and low-ranking counties are well dispersed in the state, with no single region clearly outperforming the others.

How has the ACA helped North Dakota?

At the end of 2013, there were about 70,000 uninsured residents in North Dakota. Thanks in large part to the ACA and the state’s acceptance of Medicaid expansion, 39 percent of them became eligible for Medicaid. Another 31 percent were eligible for subsidies in the exchange.

The percentage of uninsured residents dropped from 10.4 percent in 2013 to 7 percent in 2016, according to US Census data. It climbed slightly, to 7.3 percent, by 2018 (this is very much in line with the nationwide trend under the Trump administration, and North Dakota’s uninsured rate continues to be lower than the national average).

North Dakota and the Affordable Care Act

In 2010, both of North Dakota’s U.S. Senators, Democrats Kent Conrad and Byron Dorgan, were supportive of the health reform law. In the House, the Earl Pomeroy, a Democrat, and the lone representative from North Dakota, also voted yes.

The entire congressional delegation from North Dakota has changed since 2010, however, and now includes only Republicans.

Sen. John Hoeven, a Republican and the former governor, is opposed to the ACA but was one of the 23 Republicans who joined with Democrats in voting to end the debate in 2013 on a resolution that would have defunded Obamacare. However, Hoeven voted yes on all three ACA repeal measures that were considered in the Senate during the summer of 2017.

At the state level, Republicans hold the majority in both the House and Senate. Former Gov. Jack Dalrymple, a Republican, stated that he was opposed to the ACA, but he was not an obstructionist about the law the way many other Republican governors have been. In 2013, Dalrymple said, “It’s not going to help to throw a bunch of roadblocks in front of this thing [the ACA] and have it fail. That’s not the responsible thing to do.”

In the spring of 2013, Dalrymple signed a bill to expand Medicaid in the state, allowing all legal residents with incomes up to 138 percent of poverty to be eligible for Medicaid benefits starting in 2014. The state opted for a federally facilitated marketplace however, and HHS is running the exchange in North Dakota.

Doug Burgum has been the governor of North Dakota since December 2016. In late 2017, he joined with 19 other Republican governors in writing a letter to Congress, urging lawmakers to repeal the ACA.

Does North Dakota have a high-risk pool?

The Comprehensive Health Association of North Dakota (CHAND) was created in 1981 to provide an alternative for residents who were unable to purchase individual private health insurance because of their medical history. The plan is administered by Blue Cross Blue Shield of North Dakota.

Now that Obamacare is in effect and all individual major medical health insurance plans are guaranteed issue, risk pools are not needed the way they were prior to 2014. But CHAND is one of a few state-run pools that is still operational and still accepts new members if they meet the eligibility guidelines. CHAND also offers supplemental coverage for Medicare enrollees who are under 65 and unable to obtain Medigap coverage in the private market.

North Dakota Medicare enrollment

As of late 2019, Medicare enrollment in North Dakota stood at 132,317 people. That’s a little more than 17 percent of the state’s population, which is very similar to the percentage of the total US population enrolled in Medicare.